NPI | 1912079575 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA G45457) |
Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: CA G45457) |
Enumeration Date | 2006-11-15 |
Last Update Date | 2008-03-05 |