| 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 |