| NPI | 1376171330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: OR DO215561) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA PTL1705) |
| Enumeration Date | 2020-03-27 |
| Last Update Date | 2023-07-16 |