| NPI | 1073787305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: GA 79909) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: NC 2010-00219) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: PA OS017714) | |
| Enumeration Date | 2008-04-17 |
| Last Update Date | 2021-02-26 |