| NPI | 1467412528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND 7130) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: ND 7130) |
| 207QS0010X Family Medicine Sports Medicine (Licence: MI 4301081032) | |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2024-02-01 |