| NPI | 1841726148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: CA A161682) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: WA MD.MD.70158229) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: OR MD232283) | |
| Enumeration Date | 2017-05-04 |
| Last Update Date | 2026-09-18 |