| NPI | 1225141922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD18462) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA G64639) |
| 207R00000X Internal Medicine (Licence: HI MD5131) | |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2007-07-08 |