| NPI | 1710178280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME102997) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: FL ME102997) |
| 2083S0010X Preventive Medicine, Sports Medicine (Licence: FL ME102997f) | |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2024-08-15 |