| NPI | 1851457287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301055989) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: MI MS155989) |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2016-09-14 |