| NPI | 1144378167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A95408) |
| Additional Taxonomies | 2084S0010X Psychiatry & Neurology, Sports Medicine (Licence: CA A95408) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2011-09-23 |