| NPI | 1215256839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NC 2015-02102) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2015-02102) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: SC 32805) | |
| Enumeration Date | 2010-05-21 |
| Last Update Date | 2025-01-10 |