| NPI | 1245219633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME-68481) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: FL ME68481) |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2008-07-27 |