| NPI | 1942273305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine Geriatric Medicine (Licence: VA 0101237151) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D89720) |
| 207R00000X Internal Medicine (Licence: WV 25805) | |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2023-02-09 |