| NPI | 1164798351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: AZ 52713) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 52713) |
| Enumeration Date | 2012-04-01 |
| Last Update Date | 2021-05-03 |