| NPI | 1295732030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: WA MD00045927) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00045927) |
| 207Q00000X Family Medicine (Licence: ID M-10358) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2023-10-05 |