| NPI | 1205289410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: CA A157501) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 18956) |
| 207Q00000X Family Medicine (Licence: CA A157501) | |
| Enumeration Date | 2016-07-22 |
| Last Update Date | 2023-11-22 |