| NPI | 1285886366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: OR DO215124) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OL60019526) |
| Enumeration Date | 2008-10-21 |
| Last Update Date | 2023-06-20 |