| NPI | 1588283634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: WA MD61580080) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: NE 35539) |
| Enumeration Date | 2020-04-09 |
| Last Update Date | 2024-08-26 |