| NPI | 1326196809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 4681) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 20A9353) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2008-08-12 |