| NPI | 1851619183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME131955) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: VA 0101240932) |
| Enumeration Date | 2010-05-11 |
| Last Update Date | 2024-02-20 |