| NPI | 1952413114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 36801) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: CA C171319) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2023-10-03 |