NPI | 1568415701 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C 89383) |
Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: CA C 89383) |
Enumeration Date | 2006-05-18 |
Last Update Date | 2021-01-22 |