| NPI | 1659318475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME91447) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 04-27602) |
| 207R00000X Internal Medicine (Licence: MN 39715) | |
| 207R00000X Internal Medicine (Licence: WI 38274-020) | |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: FL ME91447) | |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: KS 04-27602) | |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: MN 39715) | |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: WI 38274-020) | |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2007-07-08 |