| NPI | 1891771861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 22369) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: OH 35041195) |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2008-01-23 |