| NPI | 1962924985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A15930) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: CA 20A15930) |
| Enumeration Date | 2017-07-11 |
| Last Update Date | 2023-03-07 |