| NPI | 1093986697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D81412) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101260188) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: MD D81412) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: VA 0101260188) | |
| Enumeration Date | 2008-03-22 |
| Last Update Date | 2021-07-26 |