| NPI | 1124186085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA g042378) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: CA g042378) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: CA g042378) | |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2017-03-13 |