| NPI | 1548503717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: CA A156044) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MT 50670) |
| 207Q00000X Family Medicine (Licence: CA A156044) | |
| Enumeration Date | 2013-04-05 |
| Last Update Date | 2025-05-19 |