| NPI | 1922127950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: VA 0102201857) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: NC 116912) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2014-02-07 |