| NPI | 1205855913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: CA A94409) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A94409) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2021-12-03 |