| NPI | 1336254044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: HI MD-14407) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A89829) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2021-06-15 |