| NPI | 1407870652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA G074327) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA G74327) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2010-11-05 |