| NPI | 1265475131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207RG0300X Internal Medicine Geriatric Medicine (Licence: UT 1877181205) |
| Additional Taxonomies | 2084P0805X Psychiatry & Neurology Geriatric Psychiatry (Licence: UT 1877181205) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2007-07-08 |