| NPI | 1609892736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: OR md21370) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: WA md00040249) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2007-07-08 |