| NPI | 1639288137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: FL ME68779) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME68779) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2023-03-10 |