| NPI | 1124682745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: CA 20A19673) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A19673) |
| Enumeration Date | 2019-04-29 |
| Last Update Date | 2026-06-09 |