NPI | 1497710594 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A94145) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY TP351) |
207QA0505X Family Medicine, Adult Medicine (Licence: CA A94145) | |
Enumeration Date | 2006-04-20 |
Last Update Date | 2012-12-28 |