| NPI | 1740235266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: VA 0101057080) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: MI 4301074317) |
| 207Q00000X Family Medicine (Licence: VA 0101057080) | |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2015-02-19 |