| NPI | 1437119260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 23864) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: NC 23864) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2018-10-01 |