| NPI | 1841266723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: FL ME85328) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME85328) |
| 207PS0010X Emergency Medicine, Sports Medicine (Licence: FL ME85328) | |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2026-02-12 |