| NPI | 1598841884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 24570) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A55548) |
| Enumeration Date | 2006-10-29 |
| Last Update Date | 2007-07-08 |