| NPI | 1457388696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A86501) |
| Additional Taxonomies | 2084S0010X Psychiatry & Neurology, Sports Medicine (Licence: CA A86501) |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2025-09-15 |