| NPI | 1609075878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: UT 4854640-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34.012841) |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: CA 20A14182) | |
| 208D00000X General Practice (Licence: CA 20A14182) | |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2020-10-22 |