| NPI | 1023674009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine Adult Medicine (Licence: CA A-176741) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: CA A-176741) |
| Enumeration Date | 2019-05-14 |
| Last Update Date | 2024-10-29 |