| NPI | 1336144682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 9753) |
| Additional Taxonomies | 2083S0010X Preventive Medicine, Sports Medicine (Licence: NH 9753) |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2019-06-27 |