| NPI | 1174834378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MO 2014017701) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2014017701) |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2018-10-09 |