| NPI | 1225667280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: FL os21291) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 95468) |
| Enumeration Date | 2020-04-02 |
| Last Update Date | 2024-12-16 |