| NPI | 1780690503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: NC 9601434) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: SC 22778) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2022-04-04 |