| NPI | 1962400531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: CA G79819) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G79819) |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: CA G79819) | |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2023-09-29 |