| NPI | 1942615182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: AZ 8053) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: OH 34.012392) |
| 2084S0010X Psychiatry & Neurology, Sports Medicine (Licence: OH 34.012392) | |
| 207Q00000X Family Medicine (Licence: AZ 8053) | |
| 2084S0010X Psychiatry & Neurology, Sports Medicine (Licence: AZ 008053) | |
| Enumeration Date | 2014-06-26 |
| Last Update Date | 2024-09-17 |