| NPI | 1720379753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME132228) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL me132228) |
| Enumeration Date | 2011-04-25 |
| Last Update Date | 2021-03-22 |