| NPI | 1851697809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA G65681) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: CA G65681) |
| Enumeration Date | 2011-02-08 |
| Last Update Date | 2011-02-08 |