| NPI | 1619945615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: SC SC16696) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: SC 16696) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2021-06-11 |