| NPI | 1801116884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NC 2012-01923) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 164688) |
| Enumeration Date | 2010-06-02 |
| Last Update Date | 2020-11-03 |