| NPI | 1740295419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: CA A53206) |
| Additional Taxonomies | 314000000X Skilled Nursing Facility (Licence: CA A53206) |
| 261Q00000X Clinic/Center (Licence: CA A53206) | |
| 171100000X Acupuncturist (Licence: CA A53206) | |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2026-01-22 |