| NPI | 1356406789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A99792) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2005019453) |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2014-10-30 |