| NPI | 1932381126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A39133) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA a 39133) |
| 207Q00000X Family Medicine (Licence: CA A39133) | |
| Enumeration Date | 2007-11-29 |
| Last Update Date | 2011-04-05 |