| NPI | 1780909606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NY 276592) |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: FL ME138351) |
| 207Q00000X Family Medicine (Licence: SC 35992) | |
| Enumeration Date | 2010-04-03 |
| Last Update Date | 2026-06-09 |