| NPI | 1992723886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: NE 21349) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: IA 19980) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2013-08-15 |