| NPI | 1245599778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 98617) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: GA 98617) |
| Enumeration Date | 2012-05-03 |
| Last Update Date | 2024-03-27 |