| NPI | 1508917717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX M4946) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: TX M4946) |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2007-07-08 |