| NPI | 1457388969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: VA 0101265188) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME99704) |
| 207Q00000X Family Medicine (Licence: VA 0101265188) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME99704) | |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2021-06-30 |