| NPI | 1164604526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X (Licence: FL ME87841) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: FL ME87841) |
| Enumeration Date | 2007-11-28 |
| Last Update Date | 2025-09-05 |