| NPI | 1982791463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N4120) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: OR MD26232) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2020-03-03 |