| NPI | 1033670617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine Sports Medicine (Licence: NC 2023-02227) |
| Additional Taxonomies | 207RS0010X Internal Medicine Sports Medicine (Licence: FL OS18982) |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2024-01-08 |