| NPI | 1487670717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: WY 9784A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 43744) |
| 207Q00000X Family Medicine (Licence: WY 9784A) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: CO 43744) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2022-10-13 |