| NPI | 1306942297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: MS 22163) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: TN 48835) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2018-05-01 |