| NPI | 1235700659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: MO 2024015821) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2021019869) |
| Enumeration Date | 2021-07-07 |
| Last Update Date | 2024-06-26 |