| NPI | 1578622700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G45660) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: CA G45660) |
| 207R00000X Internal Medicine (Licence: CA G45660) | |
| 207V00000X Obstetrics & Gynecology (Licence: CA G45660) | |
| 208000000X Pediatrics (Licence: CA G45660) | |
| 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: CA G45660) | |
| 208600000X Surgery (Licence: CA G45660) | |
| 208800000X Urology (Licence: CA G45660) | |
| 208C00000X Colon & Rectal Surgery (Licence: CA G45660) | |
| 208D00000X General Practice (Licence: CA G45660) | |
| 207K00000X Allergy & Immunology (Licence: CA G45660) | |
| 207N00000X Dermatology (Licence: CA G45660) | |
| 207QA0000X Family Medicine, Adolescent Medicine (Licence: CA G45660) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: CA G45660) | |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2012-11-20 |