| NPI | 1558639575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: NC 2017-01807) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: WV 22724) |
| 207RH0002X Internal Medicine, Hospice and Palliative Medicine (Licence: WV 22724) | |
| Enumeration Date | 2011-12-05 |
| Last Update Date | 2022-07-21 |