| NPI | 1245262559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME96980) |
| Additional Taxonomies | 174400000X Specialist (Licence: PR 16189) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2025-03-05 |