| NPI | 1538516646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MI 4301502363) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301502363) |
| 207Q00000X Family Medicine (Licence: FL ME133201) | |
| Enumeration Date | 2016-05-18 |
| Last Update Date | 2021-07-14 |