| NPI | 1538368014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A109450) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: CA A109450) |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2021-11-30 |