| NPI | 1275587537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: VA 0101045554) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101045554) |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: VA 0101045554) | |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2012-06-18 |