| NPI | 1255345138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A41586) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A41586) |
| 208D00000X General Practice (Licence: CA A41586) | |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2012-02-03 |