| NPI | 1043314164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: MI 4301406796) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: MI 4301406796) |
| Enumeration Date | 2006-09-11 |
| Last Update Date | 2016-09-30 |