| NPI | 1639165863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME46776) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: FL me46776) |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2016-01-28 |