| NPI | 1194875807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A79231) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: CA A79231) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2023-12-22 |