NPI | 1699006569 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: CA 20A10763) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A10763) |
Enumeration Date | 2010-01-16 |
Last Update Date | 2024-03-25 |