| NPI | 1518596584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A182075) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 39) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: CA A182075) | |
| Enumeration Date | 2020-04-02 |
| Last Update Date | 2024-09-04 |