| NPI | 1760617971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME106547) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: FL ME106547) |
| Enumeration Date | 2009-05-18 |
| Last Update Date | 2011-09-30 |