| NPI | 1043374473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G81865) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: CA G81865) |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: CA G81865) | |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2018-03-15 |