| NPI | 1689865065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A111673) |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: CA A111673) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: CA A111673) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: CA A111673) | |
| Enumeration Date | 2007-08-09 |
| Last Update Date | 2019-04-09 |