| NPI | 1548257124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: WI 19419) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: WI 19419) |
| 207R00000X Internal Medicine (Licence: WI 19419) | |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: WI 19419) | |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2023-03-07 |