| NPI | 1013130020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: PA OS013686) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OS013686) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: PA ot010558) | |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2024-02-08 |