| NPI | 1902862360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: NC 2014-01481) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: IN 01043372A) |
| 207Q00000X Family Medicine (Licence: NC 2014-01481) | |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2017-02-24 |