| NPI | 1891775938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI KD039122) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: MI KD039122) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2016-11-11 |