| NPI | 1578880332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MA 1022750) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA C156526) |
| 207Q00000X Family Medicine (Licence: MA 1022750) | |
| Enumeration Date | 2010-05-03 |
| Last Update Date | 2025-06-27 |