| NPI | 1710253141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MD D0082083) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC MD044533) |
| 207Q00000X Family Medicine (Licence: VA 0101261068) | |
| 207Q00000X Family Medicine (Licence: MD D0082083) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: VA 0101261068) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: DC MD044533) | |
| Enumeration Date | 2012-03-29 |
| Last Update Date | 2021-06-04 |