| NPI | 1679686372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0300X Internal Medicine Geriatric Medicine (Licence: OR MD 09534) |
| Additional Taxonomies | 207RG0300X Internal Medicine Geriatric Medicine (Licence: WA MD00033186) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2007-07-08 |