| NPI | 1467816868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301506915) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: PA MD474302) |
| Enumeration Date | 2016-04-12 |
| Last Update Date | 2022-11-18 |