| NPI | 1891810479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: SC 27863) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: SC 27863) |
| 207Q00000X Family Medicine (Licence: SC 27863) | |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2016-11-29 |