| NPI | 1902001621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G42711) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: CA G42711) |
| Enumeration Date | 2007-06-21 |
| Last Update Date | 2015-06-17 |