| NPI | 1568599173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: WI 77387-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 200700438) |
| 207Q00000X Family Medicine (Licence: WI 77387-20) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: GA 064986) | |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2023-09-12 |