NPI | 1972990166 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A158229) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN21203) |
Enumeration Date | 2015-04-25 |
Last Update Date | 2022-02-04 |