| NPI | 1417155151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: PA os013357) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS013357) |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2014-10-15 |