NPI | 1770012932 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: MO 2021026473) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2021026473) |
Enumeration Date | 2017-06-09 |
Last Update Date | 2024-08-15 |