| NPI | 1285868117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NC 2013-01396) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: SC MD37503) |
| Enumeration Date | 2009-05-06 |
| Last Update Date | 2020-10-25 |