| 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 |