| NPI | 1265729818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A142623) |
| Additional Taxonomies | 224Y00000X Clinical Exercise Physiologist (Licence: CA A142623) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: CA A142623) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: CA A142623) | |
| Enumeration Date | 2011-07-05 |
| Last Update Date | 2025-11-05 |