| NPI | 1720061823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C50412) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: CA C50412) |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: CA C50412) | |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2013-04-25 |