| NPI | 1063629392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: NC 2010-01796) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: NC 2010-01796) |
| 207R00000X Internal Medicine (Licence: NC 2010-01796) | |
| 2080S0010X Pediatrics, Sports Medicine (Licence: NC 2010-01796) | |
| 207Q00000X Family Medicine (Licence: NC 2010-01796) | |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2023-07-28 |