| NPI | 1760831028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: AL DO2331) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: NC 2019-01187) |
| Enumeration Date | 2016-06-08 |
| Last Update Date | 2025-02-04 |