| NPI | 1457700262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: ID M-14185) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: ID M-14185) |
| 207Q00000X Family Medicine (Licence: ID MRM-1547) | |
| 207Q00000X Family Medicine (Licence: ID M-14185) | |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2024-04-15 |