| NPI | 1245253012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A34136) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A34136) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2011-09-12 |