| NPI | 1093977621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: CA C164856) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT192993) |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2026-08-10 |