| NPI | 1801591888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: UT 14278984-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL89987) |
| Enumeration Date | 2023-03-31 |
| Last Update Date | 2026-08-26 |