| NPI | 1417070376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: FL ME108810) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL me108810) |
| 207R00000X Internal Medicine (Licence: MI 4301087752) | |
| Enumeration Date | 2007-04-07 |
| Last Update Date | 2026-04-20 |