| NPI | 1164793816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: CA 122504) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A122504) |
| Enumeration Date | 2012-01-25 |
| Last Update Date | 2024-05-08 |