| NPI | 1134264831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: CA a52468) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA a52468) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA a52468) | |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2007-07-25 |