| NPI | 1548369473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: SC 40225) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 14732) |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: VA 0101252865) | |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2020-10-22 |