| NPI | 1659937373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: ND RL15662) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101287161) |
| Enumeration Date | 2019-05-17 |
| Last Update Date | 2025-09-25 |