| NPI | 1437412806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MT 88187) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO CDR.0002695) |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2026-06-28 |