| NPI | 1194952994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: GA 87672) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116021766) |
| 207Q00000X Family Medicine (Licence: GA 87672) | |
| Enumeration Date | 2009-06-18 |
| Last Update Date | 2023-07-10 |