| NPI | 1700924388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: CA G28237) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G28237) |
| Enumeration Date | 2007-02-03 |
| Last Update Date | 2012-08-08 |