| NPI | 1487794012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 209800000X Legal Medicine (Licence: HI MD-2869) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: HI MD-2869) |
| 207RS0010X Internal Medicine, Sports Medicine (Licence: HI MD-2869) | |
| 208D00000X General Practice (Licence: HI MD-2869) | |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2025-09-11 |