| NPI | 1386888626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME116308) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: FL me116308) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: AL MD31989) | |
| 207Q00000X Family Medicine (Licence: AL MD31989) | |
| Enumeration Date | 2009-04-30 |
| Last Update Date | 2024-09-27 |