| NPI | 1902871577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: MN 24319) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: WI 24958) |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2011-07-19 |