| NPI | 1124075502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C52887) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MS 15550) |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2011-07-22 |