| NPI | 1558469379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX J7300) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: TX J7300) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2010-01-29 |