| NPI | 1780632729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: MA 290745) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A61612) |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: CA A61612) | |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: NE 24936) | |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2022-01-14 |