| NPI | 1700888377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A68537) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: CA A68537) |
| 207QS1201X Family Medicine, Sleep Medicine (Licence: CA A68537) | |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2025-03-03 |