| NPI | 1487696068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: OR MD19833) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD19833) |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2022-03-02 |