| NPI | 1699749754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: CA A62112) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 203880) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2020-09-17 |