| NPI | 1164862801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: PA OS018587) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS018587) |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2021-01-25 |