| NPI | 1588645048 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A73439) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: CA A73439) |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2021-12-13 |