| NPI | 1356578405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2012-01687) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: NC 201201687) |
| Enumeration Date | 2009-06-16 |
| Last Update Date | 2017-10-11 |