| NPI | 1659352680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: TX J4742) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: SC 22442) |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2022-01-18 |