| NPI | 1609818525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: CO 50985) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35-043524) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2015-05-26 |