| NPI | 1770741373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2011-01587) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: HI 15969) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: NC 149143) | |
| Enumeration Date | 2008-05-30 |
| Last Update Date | 2024-02-27 |