| NPI | 1871583187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: VA 0101051094) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: CA G38256) |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2023-03-07 |