| NPI | 1902093305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: HI MD15622) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A108723) |
| Enumeration Date | 2007-09-28 |
| Last Update Date | 2010-07-25 |