| NPI | 1861478505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 257848) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: NH 7892) |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: MA 257848) | |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2021-03-08 |