| NPI | 1659487056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: WA MD00046662) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: HI MD-14369) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2021-03-31 |