| NPI | 1033406368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MI 5101019321) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: MI 5101019321) |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2022-06-06 |