| NPI | 1356341606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA G77116) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 063251) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2015-07-15 |