| NPI | 1134495054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: AZ 62878) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: VT 042.0013502) |
| Enumeration Date | 2012-03-26 |
| Last Update Date | 2024-09-25 |