| NPI | 1023001948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 02005118A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 34006839) |
| 207RS0010X Internal Medicine, Sports Medicine (Licence: CO 46235) | |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2017-08-15 |