| NPI | 1942467071 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D68964) | 
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: MD D68964) | 
| 174400000X Specialist (Licence: MD 21244) | |
| Enumeration Date | 2008-05-16 | 
| Last Update Date | 2020-07-21 |