| NPI | 1134275605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA g27628) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 6428) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2010-12-06 |