| NPI | 1912915380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G64747) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: CA G64747) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2023-07-17 |