| NPI | 1457647984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: PA OS017307) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS017307) |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2026-07-10 |