| NPI | 1821035429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: GA 63947) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 0096-01707) |
| 207Q00000X Family Medicine (Licence: AR E-5890) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: NC 0096-01707) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: AR E-5890) | |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2019-09-26 |