| NPI | 1598776205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA G72838) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA G72838) |
| 208D00000X General Practice (Licence: CA G72838) | |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2008-08-14 |