NPI | 1396364147 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A182447) |
Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: CA A182447) |
Enumeration Date | 2020-04-13 |
Last Update Date | 2024-11-05 |