| NPI | 1104910488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL 9668) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: AL 9668) |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: GA 20690) | |
| 207R00000X Internal Medicine (Licence: GA 20690) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2023-10-11 |