| NPI | 1699941286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 66215) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 12677) |
| 207QS0010X Family Medicine Sports Medicine (Licence: KY 42980) | |
| Enumeration Date | 2008-05-02 |
| Last Update Date | 2021-03-29 |