| NPI | 1104802594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: CA C148038) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 20639) |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2021-06-22 |