| NPI | 1194708495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: FL ME94759) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME94759) |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2024-09-20 |