| NPI | 1396922068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A32220) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A32220) |
| Enumeration Date | 2008-01-24 |
| Last Update Date | 2008-01-31 |