| NPI | 1255366191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036-063761) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: IL 036-063761) |
| 208600000X Surgery (Licence: IL 036-063761) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2023-07-15 |