| NPI | 1316426257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: FL 11004124) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: FL 11004124) |
| Enumeration Date | 2018-08-10 |
| Last Update Date | 2024-01-31 |