| NPI | 1649267261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: CA A63257) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A63257) |
| 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: CA A63257) | |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2025-03-11 |