| NPI | 1174968077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D85499) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: SC 40570) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: MD D85499) | |
| Enumeration Date | 2013-05-06 |
| Last Update Date | 2020-06-14 |