| NPI | 1265851646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MS 28825) |
| Additional Taxonomies | 207PS0010X Emergency Medicine, Sports Medicine (Licence: MS 28825) |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2024-09-11 |