| NPI | 1881613644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA G32629) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: CA G32629) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2009-12-03 |