| NPI | 1497217210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AZ 10634) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: AZ 10634) |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2023-08-30 |