| NPI | 1801012083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A110696) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 49433) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2012-05-17 |