| NPI | 1508856691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: MA 73771) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 73771) |
| Enumeration Date | 2005-10-28 |
| Last Update Date | 2012-07-19 |