| NPI | 1780792739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: CA A044399) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A044399) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2020-04-08 |