| NPI | 1053417089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD19860) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA G36978) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2007-07-12 |