| NPI | 1164489456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA G47614) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA G47614) |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: CA G47614) | |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2012-10-08 |