| NPI | 1184786162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: GA 058438) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DE C1-0006806) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: MN 66169) | |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2022-05-10 |