| NPI | 1225564818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: CA C129160) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 54481) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: CA C-129160) | |
| Enumeration Date | 2017-05-03 |
| Last Update Date | 2021-10-13 |