| NPI | 1396806352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine Geriatric Medicine (Licence: RI PA00260) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: RI PA00260) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2008-06-25 |