| NPI | 1497963938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G50815) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: CA G50815) |
| 208D00000X General Practice (Licence: CA G50815) | |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2025-04-11 |