| NPI | 1871692574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 02751) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 2751) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: AZ 2751) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: AZ 02751) | |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2019-05-17 |