| NPI | 1356676803 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: CA A110912)  | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A110912)  | 
| Enumeration Date | 2009-10-15 | 
| Last Update Date | 2017-03-26 |