| NPI | 1730160573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: AZ 20393) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AZ 20393) |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2019-03-22 |