| NPI | 1720306756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0300X Internal Medicine Geriatric Medicine (Licence: CA G052927) |
| Additional Taxonomies | 207RG0300X Internal Medicine Geriatric Medicine (Licence: PA MD067852L) |
| 207RG0300X Internal Medicine Geriatric Medicine (Licence: DE C1-0007713) | |
| Enumeration Date | 2010-05-14 |
| Last Update Date | 2010-05-14 |