| NPI | 1740804475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: WA MD61607114) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD61607114) |
| 207R00000X Internal Medicine (Licence: MA 1014888) | |
| Enumeration Date | 2020-05-28 |
| Last Update Date | 2024-10-25 |