| NPI | 1275989667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: SC 87924) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: PA OS020477) |
| Enumeration Date | 2016-05-04 |
| Last Update Date | 2023-03-06 |