| NPI | 1699015529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: CA A135553) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: MD D0077579) |
| Enumeration Date | 2013-03-01 |
| Last Update Date | 2018-04-11 |