| NPI | 1104965383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A66300) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: CA A66300) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2007-10-30 |