| NPI | 1730620055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD221527) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: WA MD61492231) |
| 207QS0010X Family Medicine Sports Medicine (Licence: OR MD221527) | |
| 207QS0010X Family Medicine Sports Medicine (Licence: MD D0092575) | |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2024-09-18 |