| NPI | 1548823701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A179397) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 10807) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: AL 46985) | |
| Enumeration Date | 2019-04-15 |
| Last Update Date | 2024-02-01 |