| 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 |