| NPI | 1124058474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA G30036) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: CA G30036) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2008-06-20 |