| NPI | 1710970876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO12690) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: OR DO12690) |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2021-06-15 |