| NPI | 1386271427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: CT 81449) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL MD.47060) |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2025-06-03 |