| NPI | 1801250964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: VA 0101271560) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT211646) |
| Enumeration Date | 2016-04-05 |
| Last Update Date | 2024-03-14 |