| NPI | 1093973018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A103256) |
| Additional Taxonomies | 207QA0000X Family Medicine Adolescent Medicine (Licence: CA A103256) |
| 207QG0300X Family Medicine Geriatric Medicine (Licence: CA A103256) | |
| Enumeration Date | 2008-05-27 |
| Last Update Date | 2021-01-11 |