| NPI | 1265629042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME122502) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: CT 046530) |
| 207Q00000X Family Medicine (Licence: CT 046530) | |
| Enumeration Date | 2007-09-26 |
| Last Update Date | 2015-07-13 |