NPI | 1740676907 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: CA A161921) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A161921) |
Enumeration Date | 2015-04-14 |
Last Update Date | 2022-06-17 |