| NPI | 1730102153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C31572) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: CA C31572) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2017-10-05 |