| NPI | 1750425542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA G73544) |
| Additional Taxonomies | 2083S0010X Preventive Medicine, Sports Medicine (Licence: CA G73544) |
| 2083S0010X Preventive Medicine, Sports Medicine (Licence: CO 31138) | |
| 208D00000X General Practice (Licence: CO 31138) | |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2022-07-21 |