| NPI | 1104863190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine Geriatric Medicine (Licence: MI 4301047021) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301047021) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2016-02-04 |