| NPI | 1487698270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: SC 52369) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD067739L) |
| 207QS0010X Family Medicine Sports Medicine (Licence: PA MD067739L) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2018-06-06 |