| NPI | 1992736102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: WI 67579-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MR0825) |
| 207R00000X Internal Medicine (Licence: MN 50933) | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2022-07-21 |