| NPI | 1982623690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine Geriatric Medicine (Licence: NH 9210) |
| Additional Taxonomies | 207QG0300X Family Medicine Geriatric Medicine (Licence: VT 6750) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2014-06-30 |