| NPI | 1447330535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: FL ME97489) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME97489) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2023-10-13 |