| NPI | 1144532490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MO 20140124955) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: MO 2014012495) |
| Enumeration Date | 2010-07-01 |
| Last Update Date | 2024-08-21 |