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 |