| NPI | 1730408550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: OH 34.015404) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OP60298461) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: WA OP60298461) | |
| Enumeration Date | 2010-05-18 |
| Last Update Date | 2023-07-28 |