| NPI | 1831620327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: CA 20A20017) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: WA OP61566334) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: ID 3961866) | |
| Enumeration Date | 2017-03-25 |
| Last Update Date | 2024-09-23 |