| NPI | 1912040940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME95989) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: FL ME95989) |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: FL ME95989) | |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2007-07-08 |