| NPI | 1841546777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: WA MD60608436) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 4407) |
| Enumeration Date | 2012-07-30 |
| Last Update Date | 2022-07-21 |