| NPI | 1649256496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MD D74610) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MD D0074610) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2022-07-21 |