| NPI | 1770856817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA G20705) |
| Additional Taxonomies | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: CA G207050) |
| Enumeration Date | 2012-02-21 |
| Last Update Date | 2012-02-21 |