| NPI | 1144282922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: WV 11359) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 11359) |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2021-11-24 |