| NPI | 1861589962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A82130) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ND 8582) |
| 207R00000X Internal Medicine (Licence: MN 49910) | |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: MN 49910) | |
| Enumeration Date | 2006-10-09 |
| Last Update Date | 2022-03-09 |