| NPI | 1699815464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME96095) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME 96095) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2011-10-09 |