| NPI | 1831105543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: FL ME142917) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: OH 35-05-5443) |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: NC 2011-00791) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2022-09-27 |