| NPI | 1346407814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: GA 061350) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: PR 17300) |
| 207Q00000X Family Medicine (Licence: FL ME96748) | |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2010-05-13 |