| NPI | 1003244518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA G42323) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 24947) |
| Enumeration Date | 2013-10-18 |
| Last Update Date | 2013-10-18 |