| NPI | 1487033197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS20275) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: VA 0102205713) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: FL OS20275) | |
| Enumeration Date | 2015-05-27 |
| Last Update Date | 2023-06-30 |