| NPI | 1619179363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: VA 0102202325) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116018672) |
| 207Q00000X Family Medicine (Licence: VA 0102202325) | |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2023-03-29 |