| NPI | 1457467185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: WI 33748-21) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 33748) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2021-06-17 |