NPI | 1093705386 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: NC 2008-00461) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NC 200800461) |
Enumeration Date | 2005-10-27 |
Last Update Date | 2013-11-01 |