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 |