| NPI | 1083749212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: CA 20A4228) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A4228) |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: CA 20A4228) | |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2011-04-14 |