| NPI | 1841355237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: LA MD.10110R) |
| Additional Taxonomies | 174400000X Specialist (Licence: LA MD.10110R) |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2014-06-12 |