| NPI | 1972573566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MN 54590) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 4381) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2015-07-02 |