| NPI | 1205254968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: CA A145700) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA a145700) |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2024-11-06 |