| NPI | 1679604979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: PA OS013072) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS013072) |
| 207RS0010X Internal Medicine, Sports Medicine (Licence: PA OS013072) | |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2017-01-06 |