| NPI | 1336264316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: ME MD17891) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: ME EC-08-1072) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: NY 248856) | |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2025-08-25 |