| NPI | 1942311584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: IA 03815) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: SD 8418) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2023-05-30 |