| NPI | 1538276886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 44605) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: WI 44605) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2025-07-15 |