| NPI | 1386133759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NM DO2024-0131) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: CA 20A21215) |
| Enumeration Date | 2018-05-01 |
| Last Update Date | 2024-10-09 |