| NPI | 1316515364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 9032) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: IA 52945) |
| Enumeration Date | 2021-06-16 |
| Last Update Date | 2024-04-09 |