| NPI | 1104010958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: MA 219223) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 219223) |
| Enumeration Date | 2007-09-04 |
| Last Update Date | 2017-02-28 |