| NPI | 1326136714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: GA 058604) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: MN 55069) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2022-01-07 |