| NPI | 1396057899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: WI 54859) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: WI 54859-20) |
| Enumeration Date | 2010-07-13 |
| Last Update Date | 2025-05-09 |