| NPI | 1952714669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MA 1019585) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301106062) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: IL 036147889) | |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2026-08-27 |