NPI | 1740295419 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: CA A53206) |
Additional Taxonomies | 261Q00000X Clinic/Center (Licence: CA A53206) |
314000000X Skilled Nursing Facility (Licence: CA A53206) | |
171100000X Acupuncturist | |
Enumeration Date | 2006-07-30 |
Last Update Date | 2015-02-13 |