| NPI | 1811152804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: NC 00245) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: KY 61407) |
| Enumeration Date | 2008-07-19 |
| Last Update Date | 2026-06-17 |