| NPI | 1912984808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 055080) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 037371) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: GA 055080) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: CT 037371) | |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2017-12-06 |