| NPI | 1912392812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: FL OS19651) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 008130) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: PA OS019410) | |
| 207Q00000X Family Medicine (Licence: FL OS19651) | |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2025-12-05 |