| NPI | 1639137326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: FL OS17841) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: PA OS077302-E) |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2025-12-04 |