| NPI | 1649263591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C52959) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0062222) |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2007-09-28 |