| NPI | 1396306189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MO 2022022200) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2022022200) |
| 207Q00000X Family Medicine (Licence: MO 2019022927) | |
| 207Q00000X Family Medicine (Licence: MO 2022022200) | |
| Enumeration Date | 2019-06-24 |
| Last Update Date | 2023-07-12 |