| NPI | 1750378576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 9901134) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: NC 9901134) |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2024-07-15 |