| NPI | 1124092812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: NC 2020-02283) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: NH 13894) |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: MN 47614) | |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2021-03-31 |