| NPI | 1386014652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: FL OS13967) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL uo4229) |
| Enumeration Date | 2015-09-30 |
| Last Update Date | 2022-06-08 |