| NPI | 1578578365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: CA A30091) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A30091) |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2014-12-18 |