| NPI | 1679562623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: NY 238564) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: ME MD19429) |
| 207R00000X Internal Medicine (Licence: ME MD19429) | |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2018-05-01 |