| NPI | 1760509657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: AR E-5068) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E5068) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2016-12-09 |