| NPI | 1972614519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO MD116326) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: MO 116326) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2026-08-12 |