| NPI | 1023051265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME98413) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301079607) |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: MI 4301079607) | |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: FL ME98413) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2012-05-21 |