| NPI | 1386778033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A780920) |
| Additional Taxonomies | 174400000X Specialist (Licence: 00A780920) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2013-10-01 |