| NPI | 1922161223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: NC 2007-01903) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT183799) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2013-05-28 |