| NPI | 1497841530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: AR E-7389) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2004017667) |
| 207Q00000X Family Medicine (Licence: SC 31290) | |
| 207QS0010X Family Medicine Sports Medicine (Licence: SC 31290) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2012-02-09 |