| NPI | 1558312629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C51374) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA FNP31727) |
| Enumeration Date | 2006-05-13 |
| Last Update Date | 2013-04-18 |