| NPI | 1538230552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME78346) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA C51882) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2008-07-23 |