| NPI | 1083205249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: AL 51447) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL85898) |
| 208000000X Pediatrics (Licence: SC LL85898) | |
| Enumeration Date | 2021-01-31 |
| Last Update Date | 2025-06-24 |