NPI | 1699126730 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QG0300X Family Medicine Geriatric Medicine (Licence: CA 16167) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A16167) |
Enumeration Date | 2016-06-30 |
Last Update Date | 2023-11-21 |