| NPI | 1427373539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101256364) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: VA 0101256364) |
| Enumeration Date | 2010-03-31 |
| Last Update Date | 2014-07-21 |