| NPI | 1447755764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: WA OP61321865) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34.016643) |
| 207Q00000X Family Medicine (Licence: WA OL61068377) | |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2024-07-30 |