| NPI | 1003975954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RS0010X Internal Medicine Sports Medicine (Licence: FL ME77922) |
| Additional Taxonomies | 207RA0401X Internal Medicine Addiction Medicine (Licence: FL ME77922) |
| Enumeration Date | 2006-12-07 |
| Last Update Date | 2011-08-14 |