| NPI | 1457889370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0300X Internal Medicine Geriatric Medicine (Licence: MI 5101025639) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101025639) |
| Enumeration Date | 2017-05-23 |
| Last Update Date | 2024-04-11 |