| NPI | 1477714889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL MD 34604) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME 105070) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: AL MD 34604) | |
| Enumeration Date | 2008-06-18 |
| Last Update Date | 2023-12-01 |