| NPI | 1215155692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 061941) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA RTP 1193) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: GA RTP 1193) | |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2022-01-07 |