| NPI | 1073961439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: WA MD61062541) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD61062541) |
| 207Q00000X Family Medicine (Licence: UT 11195819-1205) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: UT 11195819-1205) | |
| Enumeration Date | 2016-05-26 |
| Last Update Date | 2023-01-21 |