| NPI | 1477833408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA G89366) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036.108452) |
| Enumeration Date | 2011-08-22 |
| Last Update Date | 2013-05-18 |