| NPI | 1225094972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME96094) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: FL 96094) |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2010-06-02 |