NPI | 1114955077 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A76048) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A76048) |
Enumeration Date | 2006-06-29 |
Last Update Date | 2021-12-20 |