| NPI | 1205042470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: CA A120608) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 225913) |
| 207Q00000X Family Medicine (Licence: CA A120608) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: MA 235987) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2021-04-15 |