| NPI | 1932787538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083S0010X Preventive Medicine, Sports Medicine (Licence: ND 24301) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: OH 35.153355) |
| 207Q00000X Family Medicine (Licence: CA A193397) | |
| Enumeration Date | 2021-04-02 |
| Last Update Date | 2026-08-13 |