| NPI | 1093370892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: CA A182426) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A182426) |
| 207Q00000X Family Medicine (Licence: NC 2021-02470) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: NC 2021-02470) | |
| Enumeration Date | 2019-05-07 |
| Last Update Date | 2025-06-02 |