| NPI | 1255021564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ R80237) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: NE 10475) |
| Enumeration Date | 2023-05-10 |
| Last Update Date | 2026-06-18 |