NPI | 1619010121 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: CA G0381130) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA G0381130) |
2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: CA G0381130) | |
Enumeration Date | 2007-02-14 |
Last Update Date | 2007-07-09 |