| NPI | 1629010327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: CA A96253) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN MD40312) |
| 207Q00000X Family Medicine (Licence: CA A96253) | |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2017-12-01 |