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 |