| NPI | 1902018252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: MA 1016266) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: FL ME96375) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2024-01-30 |