| NPI | 1134186331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 17122) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: WV 17122) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2022-04-06 |