| NPI | 1891141446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NV DO2581) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A16032) |
| Enumeration Date | 2016-05-12 |
| Last Update Date | 2019-09-26 |