| NPI | 1952415846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: FL ME98096) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 229512) |
| 207R00000X Internal Medicine (Licence: KY 50147) | |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2017-04-21 |