| NPI | 1891928263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A107131) |
| Additional Taxonomies | 251K00000X Public Health or Welfare (Licence: CA 550000708) |
| Enumeration Date | 2009-09-01 |
| Last Update Date | 2012-08-23 |