NPI | 1710544077 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A19481) |
Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: CA 20A19481) |
Enumeration Date | 2019-05-22 |
Last Update Date | 2024-08-13 |