| NPI | 1992851505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: CT 60148) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: OK 4764) |
| 207Q00000X Family Medicine (Licence: CT 60148) | |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2018-11-09 |