| NPI | 1982081766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NC 2018-01079) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2018-01079) |
| Enumeration Date | 2015-04-30 |
| Last Update Date | 2021-03-30 |