| NPI | 1487663308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: ME MD18929) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 48736) |
| 207Q00000X Family Medicine (Licence: ME MD18929) | |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2012-09-05 |