| NPI | 1376798728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: MA 250923) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: MA 250923) |
| Enumeration Date | 2008-11-26 |
| Last Update Date | 2023-10-12 |