| NPI | 1780872366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A51569) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: CA A51569) |
| Enumeration Date | 2007-10-09 |
| Last Update Date | 2012-02-07 |