| NPI | 1336889096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: WI 85367-20) |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: WI 85367-20) |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2025-06-26 |