| NPI | 1942309695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL 85672) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: CO 34708) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: FL 85672) | |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2022-12-09 |