NPI | 1548581192 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A136424) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A136424) |
Enumeration Date | 2010-06-17 |
Last Update Date | 2024-02-25 |