| NPI | 1356760938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: MA 274719) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 274719) |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: MA 260502) | |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2023-06-09 |