NPI | 1679551352 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A447380) |
Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: CA A44738) |
207RS0010X Internal Medicine, Sports Medicine (Licence: CA A447380) | |
Enumeration Date | 2006-01-04 |
Last Update Date | 2010-02-19 |