| NPI | 1982622718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: NC 200201459) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036-114084) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2013-09-19 |