| NPI | 1780974063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: PR 18155) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 18155) |
| 208D00000X General Practice (Licence: PR 18155) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 18155) | |
| Enumeration Date | 2011-04-07 |
| Last Update Date | 2021-08-31 |