| NPI | 1861735359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NY 298566) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 298566) |
| 207Q00000X Family Medicine (Licence: WA MD60762868) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: WA MD60762868) | |
| Enumeration Date | 2013-04-03 |
| Last Update Date | 2024-09-18 |