| NPI | 1215137815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: CA 100278) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A100278) |
| Enumeration Date | 2007-07-20 |
| Last Update Date | 2022-02-11 |