| NPI | 1134417991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: MO 106526) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: CA G46379) |
| Enumeration Date | 2011-07-14 |
| Last Update Date | 2011-07-14 |