| NPI | 1538514948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 3316) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: TN 3316) |
| 207Q00000X Family Medicine (Licence: NC 2019-01901) | |
| Enumeration Date | 2016-05-04 |
| Last Update Date | 2021-03-30 |