| NPI | 1578722781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: SD 8929) |
| Additional Taxonomies | 207PS0010X Emergency Medicine, Sports Medicine (Licence: IA MD-39087) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: NE 27606) | |
| Enumeration Date | 2008-06-03 |
| Last Update Date | 2015-10-26 |