| NPI | 1982655858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA G73664) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA G73664) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2007-07-08 |