| NPI | 1013144419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: VA 0101247923) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116021437) |
| Enumeration Date | 2009-06-12 |
| Last Update Date | 2023-11-27 |