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 |