| NPI | 1871531699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G480540) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: CA G480540) |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2007-07-08 |