| NPI | 1184136558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: MO 2017038041) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: MO 2017038041) |
| 207R00000X Internal Medicine (Licence: MO 2017038041) | |
| 207Q00000X Family Medicine (Licence: MO 2017038041) | |
| Enumeration Date | 2017-10-25 |
| Last Update Date | 2022-02-16 |