| NPI | 1184243008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: IA MD-53592) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA MD-53592) |
| 207Q00000X Family Medicine (Licence: TX U0077) | |
| Enumeration Date | 2020-04-10 |
| Last Update Date | 2025-01-02 |