| NPI | 1912355462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: CO 0070850) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MRM-1572) |
| 207Q00000X Family Medicine (Licence: ID M-13866) | |
| Enumeration Date | 2016-05-25 |
| Last Update Date | 2023-05-12 |