| NPI | 1043352982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: FL ME141484) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: NY 221406) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2023-03-07 |