| NPI | 1598789356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A47852) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL 56773) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: FL 56773) | |
| 207L00000X Anesthesiology (Licence: CA A47852) | |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2020-04-01 |