NPI | 1558312629 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C51374) |
Additional Taxonomies | 208D00000X General Practice (Licence: CA FNP31727) |
Enumeration Date | 2006-05-13 |
Last Update Date | 2013-04-18 |