| NPI | 1427328533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 82082) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS13394) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: SC 82082) | |
| Enumeration Date | 2012-01-05 |
| Last Update Date | 2022-08-31 |