NPI | 1265497283 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A30625) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A30625) |
Enumeration Date | 2006-04-20 |
Last Update Date | 2010-07-22 |