| NPI | 1316471303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: LA 338082) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 338082) |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2023-10-24 |