| NPI | 1346690468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: FL ME138799) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: MD D0090280) |
| Enumeration Date | 2016-06-20 |
| Last Update Date | 2024-03-18 |