| 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 |