| NPI | 1558476663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV 14295) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A72951) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2012-04-18 |