NPI | 1578973350 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A145388) |
Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: CA A145388) |
Enumeration Date | 2014-05-02 |
Last Update Date | 2018-09-13 |