| NPI | 1528039856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: AZ AZ3490) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: AZ 3490) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2022-03-02 |