| NPI | 1861606790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: CA G39185) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: WA MD00026952) |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: OH 35.051664) | |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: OR MD18537) | |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2019-07-07 |