| NPI | 1396831889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A88769) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: CA A88769) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2007-07-08 |