| NPI | 1992754832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C52129) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301060886) |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2012-02-14 |