| NPI | 1871674036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083S0010X Preventive Medicine, Sports Medicine (Licence: VT 042-0010546) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VT 042.0010546) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2016-01-07 |