| NPI | 1851398077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: TN 36919) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: MS 17920) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: DC MD035836) | |
| Enumeration Date | 2005-07-01 |
| Last Update Date | 2023-03-07 |