| NPI | 1679887533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: HI 17531) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: TN 51232) |
| Enumeration Date | 2010-08-03 |
| Last Update Date | 2014-05-28 |