| NPI | 1073603361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QH0002X Family Medicine Hospice and Palliative Medicine (Licence: CA 20A6429) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A6429) |
| 207QG0300X Family Medicine Geriatric Medicine (Licence: CA 20A6429) | |
| Enumeration Date | 2006-10-15 |
| Last Update Date | 2021-05-24 |