| NPI | 1073527099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA G74781) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA G074781) |
| 208600000X Surgery (Licence: CA G74781) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2010-04-02 |