| NPI | 1477785681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA a113859) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: CA a113859) |
| Enumeration Date | 2009-08-20 |
| Last Update Date | 2026-02-04 |