| NPI | 1669652806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 21395) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101047551) |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: VA 0101047551) | |
| Enumeration Date | 2007-11-05 |
| Last Update Date | 2014-07-25 |