| NPI | 1902901952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101240536) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA G67501) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2007-07-08 |