| NPI | 1962440867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: MI 4301085843) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI AP085843) |
| 207R00000X Internal Medicine (Licence: MI 4301085843) | |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2015-01-27 |