NPI | 1881742062 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA G73037) |
Additional Taxonomies | 208000000X Pediatrics (Licence: CA G73037) |
Enumeration Date | 2007-01-06 |
Last Update Date | 2017-05-02 |