| NPI | 1417793092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: CA 95077364) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: CA 95077364) |
| Enumeration Date | 2024-07-03 |
| Last Update Date | 2024-07-03 |