NPI | 1487804308 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: CA 20A10511) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A10511) |
207QS0010X Family Medicine, Sports Medicine (Licence: CA 20A10511) | |
2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: CA 20A10511) | |
Enumeration Date | 2008-09-28 |
Last Update Date | 2008-09-28 |