| NPI | 1063984094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: MI 4704280046) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 4704280046) |
| Enumeration Date | 2019-01-02 |
| Last Update Date | 2019-01-02 |