NPI | 1346219557 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: CA A66601) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A66601) |
Enumeration Date | 2006-03-17 |
Last Update Date | 2021-09-01 |