| NPI | 1447599592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA G44547) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO 42473) |
| Enumeration Date | 2013-02-10 |
| Last Update Date | 2013-02-10 |