| NPI | 1932100807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA G66543) |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory (Licence: CA G66543) |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2013-05-10 |