| NPI | 1083714323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: VA 0102202092) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 207Q00000X Family Medicine (Licence: VA 0102202092) | |
| 208U00000X Clinical Pharmacology (Licence: VA 0102202092) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2023-08-22 |