| NPI | 1063831352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 306145) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: LA 306145) |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2023-01-27 |