| NPI | 1144479882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A101206) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301095756) |
| Enumeration Date | 2008-09-18 |
| Last Update Date | 2011-01-18 |