| NPI | 1215016175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: CA A81146) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: CA A81146) |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2020-12-09 |