| NPI | 1306307285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: ME MD29523) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME MD29523) |
| 207Q00000X Family Medicine (Licence: NC 2022-02231) | |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2025-08-13 |