| NPI | 1932545746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0300X Internal Medicine Geriatric Medicine (Licence: NC 2016-01560) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2016-01560) |
| 207R00000X Internal Medicine (Licence: AZ R73908) | |
| Enumeration Date | 2013-05-20 |
| Last Update Date | 2019-08-19 |