| NPI | 1417535360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: AR E-17976) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX T9799) |
| 207Q00000X Family Medicine (Licence: AR E-17976) | |
| Enumeration Date | 2021-03-31 |
| Last Update Date | 2025-05-23 |