| 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 |