| NPI | 1427445162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 64018) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A155182) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: CA A155182) | |
| Enumeration Date | 2015-04-21 |
| Last Update Date | 2021-02-01 |