| NPI | 1295707784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: VA 0101238231) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA C161212) |
| 207Q00000X Family Medicine (Licence: VA 0101238231) | |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2023-07-09 |