| NPI | 1770636714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS004503L) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: PA OS004503L) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2009-02-09 |