| NPI | 1164416517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G29685) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: GA 79889) |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2024-08-21 |