| NPI | 1013041003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA G42434) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO 41348) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2016-03-24 |