| NPI | 1790758084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: MN 42599) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: MN 42599) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2023-04-07 |