| NPI | 1275578304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: CA A67110) |
| Additional Taxonomies | 207QA0401X Family Medicine Addiction Medicine (Licence: CA A67110) |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2016-03-01 |