| NPI | 1316158512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME97553) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME97553) |
| 207Q00000X Family Medicine (Licence: FL ME 97553) | |
| Enumeration Date | 2007-05-28 |
| Last Update Date | 2026-01-28 |