| NPI | 1013995612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 9500044) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: NC 95-00044) |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2025-09-11 |