| NPI | 1134186331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX U7830) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 17122) |
| 207RG0300X Internal Medicine Geriatric Medicine (Licence: WV 17122) | |
| 207RG0300X Internal Medicine Geriatric Medicine (Licence: TX U7830) | |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2024-07-24 |