| NPI | 1164692703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A79979) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A79979) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: CA A79979) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: CA A79979) | |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: CA A79979) | |
| Enumeration Date | 2008-03-11 |
| Last Update Date | 2020-03-04 |