| NPI | 1770732406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: VA 0102204849) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: GA 072746) |
| Enumeration Date | 2008-09-18 |
| Last Update Date | 2023-12-04 |