| NPI | 1316367196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: FL OS14970) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: KY 04125) |
| 207R00000X Internal Medicine (Licence: FL OS14970) | |
| Enumeration Date | 2014-04-21 |
| Last Update Date | 2020-03-11 |