| NPI | 1851520936 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: MD D0071199)  | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0071199)  | 
| Enumeration Date | 2009-07-09 | 
| Last Update Date | 2010-07-30 |