| NPI | 1104400522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: LA 346505) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: IN 02007367A) |
| Enumeration Date | 2021-05-11 |
| Last Update Date | 2025-08-28 |