| NPI | 1700046547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2011-01186) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: NC 2011-01186) |
| 207RS0010X Internal Medicine, Sports Medicine (Licence: NC 2011-01186) | |
| 208D00000X General Practice (Licence: NC 2011-01186) | |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2023-12-18 |