| NPI | 1699903211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NC 2011-01152) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2011-01152) |
| 208D00000X General Practice (Licence: NC 2011-01152) | |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2025-11-06 |