| NPI | 1295955938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 20A6561) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A6561) |
| 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: CA 20A6561) | |
| 208000000X Pediatrics (Licence: CA 20A6561) | |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2011-05-19 |