| NPI | 1306108279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: AR E9863) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: GA 82480) |
| Enumeration Date | 2012-06-15 |
| Last Update Date | 2019-08-12 |