| NPI | 1902246796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine Geriatric Medicine (Licence: TX T9921) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX T9921) |
| 207R00000X Internal Medicine (Licence: MO 2013019618) | |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2022-11-29 |