| NPI | 1437287497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME96407) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME 96407) |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2022-10-13 |