| NPI | 1992702146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A6400) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: CA 20A6400) |
| Enumeration Date | 2005-07-01 |
| Last Update Date | 2016-08-30 |