| NPI | 1124384110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: CA A133799) |
| Additional Taxonomies | 314000000X Skilled Nursing Facility (Licence: CA A133799) |
| Enumeration Date | 2012-04-04 |
| Last Update Date | 2022-02-11 |