| NPI | 1902828130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 9700303) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: NC 9700303) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NC 9700303) | |
| 208D00000X General Practice (Licence: NC 9700303) | |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2023-03-09 |