| NPI | 1285295808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME147663) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: FL ME147663) |
| Enumeration Date | 2019-06-25 |
| Last Update Date | 2023-08-08 |