| NPI | 1982627121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: PA MD438632) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD438632) |
| 174400000X Specialist (Licence: TX EO168) | |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2012-04-11 |