| NPI | 1356039051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PA 33262189) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: PA 33262189) |
| Enumeration Date | 2023-05-01 |
| Last Update Date | 2023-05-01 |