| NPI | 1881642791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA G46383) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 45678) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2010-07-19 |