| NPI | 1093195398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME130000) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: FL ME130000) |
| Enumeration Date | 2015-06-02 |
| Last Update Date | 2025-08-22 |