| NPI | 1770781031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: OR MD164471) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2007019795) |
| 208M00000X Hospitalist (Licence: OR MD164471) | |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2020-01-28 |