| NPI | 1265750970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: MA 268462) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VT 042-0012235) |
| Enumeration Date | 2010-05-06 |
| Last Update Date | 2016-11-03 |