| NPI | 1487175428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: FL OS14829) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL UO4772) |
| 207Q00000X Family Medicine (Licence: FL OS14829) | |
| Enumeration Date | 2017-06-29 |
| Last Update Date | 2018-09-19 |