NPI | 1104994268 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A86101) |
Additional Taxonomies | 208000000X Pediatrics (Licence: CA A86101) |
Enumeration Date | 2006-11-30 |
Last Update Date | 2014-01-28 |