| NPI | 1962039081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: TX W0292) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX W0292) |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2025-08-11 |