| NPI | 1427444207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NC 2021-03276) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: OH 35.137247) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME129337) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: WV 29204) | |
| Enumeration Date | 2015-04-08 |
| Last Update Date | 2022-03-15 |