| NPI | 1336400159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: SC 34665) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 34665) |
| Enumeration Date | 2012-06-07 |
| Last Update Date | 2019-02-25 |