| NPI | 1710097860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: CA G21975) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA G21975) |
| 207Q00000X Family Medicine (Licence: CA G21975) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2009-05-21 |