| NPI | 1184804437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD126187) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A101420) |
| Enumeration Date | 2007-11-04 |
| Last Update Date | 2009-08-19 |