| NPI | 1053596296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: GA 063165) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 002629) |
| 207Q00000X Family Medicine (Licence: GA 063165) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: GA 63165) | |
| Enumeration Date | 2008-01-07 |
| Last Update Date | 2020-10-12 |