| NPI | 1972576270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C56218) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD068688L) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2013-12-31 |