| NPI | 1437619103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME164291) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301506961) |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2024-04-01 |