NPI | 1922009638 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 033402) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 033402) |
Enumeration Date | 2005-08-03 |
Last Update Date | 2010-11-12 |