| NPI | 1295968311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS16317) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: MO 2014024991) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: FL OS16317) | |
| Enumeration Date | 2009-08-24 |
| Last Update Date | 2022-03-24 |