| NPI | 1184253726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: CA 20A23500) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A23500) |
| Enumeration Date | 2020-04-06 |
| Last Update Date | 2026-03-25 |