| NPI | 1801872338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: NM 85-163) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM 85-163) |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2007-11-19 |