| NPI | 1851336150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: FL ME1004444) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: PR 14135) |
| Enumeration Date | 2006-06-19 |
| Last Update Date | 2008-04-09 |