| NPI | 1417033291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G59842) |
| Additional Taxonomies | 207QA0000X Family Medicine Adolescent Medicine (Licence: CA G59842) |
| 207QA0505X Family Medicine Adult Medicine (Licence: CA G59542) | |
| 207QG0300X Family Medicine Geriatric Medicine (Licence: CA G59842) | |
| 207QS0010X Family Medicine Sports Medicine (Licence: CA G59842) | |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2019-10-04 |