| NPI | 1871908970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: FL ME141851) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301106145) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: MI 4301106145) | |
| Enumeration Date | 2014-06-26 |
| Last Update Date | 2023-09-07 |