| NPI | 1386055069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 056412) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: CT 56412) |
| Enumeration Date | 2014-05-15 |
| Last Update Date | 2018-10-05 |