| NPI | 1467403675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: AZ 009931) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101015599) |
| 207Q00000X Family Medicine (Licence: AZ 009931) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: FL OS17051) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: MI 5101015599) | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2022-11-26 |