| NPI | 1982807657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A102393) |
| Additional Taxonomies | 207QG0300X Family Medicine Geriatric Medicine (Licence: MN 50031) |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2021-12-13 |