| NPI | 1336501402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA MD-46125) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: IA MD-46125) |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2020-07-06 |