| NPI | 1932469871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: AZ 006235) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: UT 9355610-1204) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: HI DOS-2354) | |
| Enumeration Date | 2012-05-25 |
| Last Update Date | 2026-07-01 |