| NPI | 1518981745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: NC 9601245) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: NC 9601245) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2026-08-11 |