| NPI | 1063414134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX d8154) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: TX d8154) |
| Enumeration Date | 2005-06-02 |
| Last Update Date | 2016-03-18 |