| NPI | 1851361919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: HI MD-14508) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA GFE56709) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: HI MD-14508) | |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2023-09-15 |