| NPI | 1568636413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX M8390) |
| Additional Taxonomies | 207RG0300X Internal Medicine Geriatric Medicine (Licence: TX M8390) |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2009-10-27 |