| NPI | 1720048788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 9300311) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: NC 93-00311) |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: NC 9300311) | |
| 204R00000X Electrodiagnostic Medicine (Licence: NC 9300311) | |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2016-06-23 |