| NPI | 1063638369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD25953) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA G26607) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2011-11-14 |