| NPI | 1629203815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: FL OS20600) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS20600) |
| 207RS0010X Internal Medicine, Sports Medicine (Licence: ND 14269) | |
| Enumeration Date | 2009-05-18 |
| Last Update Date | 2024-01-30 |