| NPI | 1972749034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: NC 2011-01121) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2011-01121) |
| 207R00000X Internal Medicine (Licence: VA 0101263433) | |
| Enumeration Date | 2008-12-19 |
| Last Update Date | 2022-12-19 |