| NPI | 1891795316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: CT 043632) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 232460) |
| Enumeration Date | 2005-07-27 |
| Last Update Date | 2023-05-02 |