| NPI | 1396858718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: WA MD60027229) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: CA A100584) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2009-09-09 |