| NPI | 1609839109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: OK 25663) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101-237703) |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2011-02-07 |