| NPI | 1154313971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: CA GFE83510) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: PA MD044935L) |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2014-04-29 |