| NPI | 1679153779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: TX 1002875) |
| Additional Taxonomies | 2084P0805X (Licence: TX 1002875) |
| Enumeration Date | 2021-04-12 |
| Last Update Date | 2025-05-07 |