| NPI | 1134430747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: MA 257465) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 245455) |
| Enumeration Date | 2010-06-29 |
| Last Update Date | 2020-01-03 |