| NPI | 1750949293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: PA OS023680) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT019959) |
| Enumeration Date | 2019-05-30 |
| Last Update Date | 2024-09-27 |