| NPI | 1659596435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: CA A119794) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: MA 245518) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2017-03-09 |