| NPI | 1922238245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: MN 52987) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 57008) |
| 207QS0010X Family Medicine Sports Medicine (Licence: WI 57008) | |
| Enumeration Date | 2009-07-21 |
| Last Update Date | 2023-06-13 |