| NPI | 1114011459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS20329) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A9497) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: CA 20A9497) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2024-07-31 |