| NPI | 1306811955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0063981) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A84269) |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2013-07-22 |