| NPI | 1043347149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MD D50570) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: VA 0101225211) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: DC MD30121) | |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2024-05-07 |