| NPI | 1063161461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI MD-26868) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: HI MD-26868) |
| Enumeration Date | 2022-03-22 |
| Last Update Date | 2026-09-02 |