| NPI | 1093797136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: WV 33178) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: MI JM063478) |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2024-02-09 |