| NPI | 1992780852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: KS 22870) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: MO R5P18) |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2008-04-29 |