| NPI | 1023093994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: NY 166195) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 58101) |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: MA 58101) | |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2020-07-06 |