| NPI | 1376552901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 79686) |
| Additional Taxonomies | 207RG0300X Internal Medicine Geriatric Medicine (Licence: MA 79686) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2023-03-07 |