| NPI | 1649395666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: HI 14365) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A96011) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2008-05-19 |