| NPI | 1093988578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: ID O-0970) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 4663) |
| 207Q00000X Family Medicine (Licence: MO 2013021818) | |
| Enumeration Date | 2008-04-07 |
| Last Update Date | 2018-08-13 |