| NPI | 1497760219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 5101012478) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 20A10469) |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2013-07-01 |