| NPI | 1003885989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA G85468) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 44210) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2008-10-30 |