| NPI | 1528588589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NH 38700) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NH 38700) |
| 207Q00000X Family Medicine (Licence: MA 287425) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: MA 287425) | |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2025-11-28 |