| NPI | 1033178819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C53926) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 48069) |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2012-04-20 |