| NPI | 1588621742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E2799) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E-2799) |
| 207QS0010X Family Medicine Sports Medicine (Licence: AR E-2799) | |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2022-09-14 |