| NPI | 1164866091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: PA OS018047) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS018047) |
| Enumeration Date | 2013-04-22 |
| Last Update Date | 2023-03-15 |