| NPI | 1033465505 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: MN 60543) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX T6340) |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: OH 35.125457) | |
| Enumeration Date | 2012-08-01 |
| Last Update Date | 2022-09-13 |