| NPI | 1295711877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: CA C192117) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101102523) |
| 207Q00000X Family Medicine (Licence: WA MD60884572) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: WA MD60884572) | |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2024-12-30 |