| NPI | 1629138698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 62086) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: SC MD34333) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: GA 62086) | |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2024-08-20 |