| NPI | 1316131998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: TN DO2151) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: NC 2009-01336) |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2012-02-03 |