| NPI | 1235193616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA G81075) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA G81075) |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2007-07-09 |