| NPI | 1003875931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: CT 024786) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 024786) |
| Enumeration Date | 2006-03-20 |
| Last Update Date | 2013-05-31 |