| NPI | 1952403651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2009024720) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: WI 29906) |
| 207P00000X Emergency Medicine (Licence: WI 29906) | |
| 207Q00000X Family Medicine (Licence: WI 29906) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: MO 2009024720) | |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2014-09-04 |