| NPI | 1841250057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 56264) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: MS 11795) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2014-02-07 |