| NPI | 1144225897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: CA C34967) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: CA C34967) |
| 207Q00000X Family Medicine (Licence: CA C34967) | |
| Enumeration Date | 2005-06-18 |
| Last Update Date | 2017-03-02 |