| NPI | 1760688998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME108685) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 51995) |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2023-10-09 |