| NPI | 1386054484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL ME151532) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: DE C10012721) |
| Enumeration Date | 2014-04-29 |
| Last Update Date | 2025-11-19 |