| NPI | 1902095128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: WA 60555449) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 231032) |
| Enumeration Date | 2007-10-24 |
| Last Update Date | 2018-04-16 |