| NPI | 1689935355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: CA A132857) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: CA A132857) |
| 207Q00000X Family Medicine (Licence: CA A132857) | |
| Enumeration Date | 2012-05-30 |
| Last Update Date | 2022-07-21 |