| NPI | 1568996338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: CA A195411) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: PA MD472566) |
| Enumeration Date | 2017-04-18 |
| Last Update Date | 2025-04-16 |