| NPI | 1447679667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: CA A138959) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A138959) |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2020-10-16 |