| NPI | 1508969817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NH 16038) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME 015920) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2014-02-07 |