| NPI | 1679533517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: TX G3067) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX G3067) |
| 207R00000X Internal Medicine (Licence: TX G3067) | |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2012-06-12 |