| NPI | 1508896275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A93662) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A93662) |
| 207Q00000X Family Medicine (Licence: CA A93662) | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2012-08-07 |