| NPI | 1972921096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: AL 44895) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 49863) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: TN 57588) | |
| Enumeration Date | 2014-04-04 |
| Last Update Date | 2023-06-28 |