NPI | 1386702140 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: CA 12689) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS17840) |
Enumeration Date | 2006-12-05 |
Last Update Date | 2023-03-07 |