| NPI | 1710423405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A157310) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: CA A157310) |
| 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: CA A157310) | |
| Enumeration Date | 2017-01-18 |
| Last Update Date | 2022-04-11 |