| NPI | 1962033498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101273008) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: VA 010273008) |
| Enumeration Date | 2020-02-03 |
| Last Update Date | 2023-08-31 |