| NPI | 1598717662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: MT 11792) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 57672501204) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: MN 59970) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2025-04-10 |