| 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 |