| NPI | 1669768305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: AZ 58046) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: WY 9522A) |
| Enumeration Date | 2011-06-21 |
| Last Update Date | 2023-09-28 |