| NPI | 1538164157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME82799) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: FL ME82799) |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2023-08-04 |