| NPI | 1801066204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: IL 036.136222) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.098942) |
| 208000000X Pediatrics (Licence: OH 35.098942) | |
| Enumeration Date | 2008-03-03 |
| Last Update Date | 2014-09-18 |