| NPI | 1336332519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WY 6364V) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO 34541) |
| 207R00000X Internal Medicine (Licence: CA G20936) | |
| Enumeration Date | 2007-08-22 |
| Last Update Date | 2007-08-22 |