| NPI | 1497727283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: NC 2008-01930) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 20403) |
| 207Q00000X Family Medicine (Licence: NC 2008-01930) | |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2021-09-23 |