| NPI | 1538854856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: CA 20A23733) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: CA 20A23733) | |
| Enumeration Date | 2023-04-11 |
| Last Update Date | 2025-06-23 |