| NPI | 1083697726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine Geriatric Medicine (Licence: CT 023639) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 023639) |
| 207ZP0101X Pathology Anatomic Pathology (Licence: CT 023639) | |
| Enumeration Date | 2005-11-28 |
| Last Update Date | 2014-04-04 |