NPI | 1942662796 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: CA A159204) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2016-03-22 |
Last Update Date | 2020-06-29 |