| NPI | 1528045952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine Geriatric Medicine (Licence: MN 22557) |
| Additional Taxonomies | 207QG0300X Family Medicine Geriatric Medicine (Licence: MN 22557) |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2020-08-20 |