| NPI | 1053632521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: CA A181623) |
| Additional Taxonomies | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: FL ME136652) |
| 207R00000X Internal Medicine (Licence: FL ME136652) | |
| Enumeration Date | 2010-06-18 |
| Last Update Date | 2025-12-18 |