| NPI | 1780656512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: CA A54499) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A54499) |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2019-07-09 |