| NPI | 1972894921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: FL ME123543) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2013-01760) |
| 207Q00000X Family Medicine (Licence: FL ME123543) | |
| Enumeration Date | 2011-04-26 |
| Last Update Date | 2019-10-17 |