| NPI | 1730167552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301041018) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: MI SW041018) |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2011-12-29 |