| NPI | 1932135548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207QG0300X Family Medicine Geriatric Medicine (Licence: MD D22663) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MD D22663) |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2023-03-07 |