| NPI | 1073007878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: PA os020727) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS020727) |
| 207Q00000X Family Medicine (Licence: PA OT018708) | |
| Enumeration Date | 2018-06-15 |
| Last Update Date | 2023-02-13 |