| NPI | 1104851658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301050548) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: MI 430150548) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2018-06-19 |