| NPI | 1942508866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2012-01493) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV AB8675398012) |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: NC 2012-01493) | |
| Enumeration Date | 2011-03-01 |
| Last Update Date | 2016-12-08 |