| NPI | 1346866357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 82812-20) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: WI 82812-20) |
| Enumeration Date | 2020-06-25 |
| Last Update Date | 2024-09-11 |