| NPI | 1528021425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 45776) |
| Additional Taxonomies | 174400000X Specialist (Licence: MA AF45776) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: MA 45776) | |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2011-10-04 |