| NPI | 1003956863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 00A44405) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA 00A44405) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2007-07-08 |