| NPI | 1548317167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A36755) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A36755) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: CA A36755) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: CA A36755) | |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2010-09-17 |