| NPI | 1144648809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: FL 1501139060) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 1144648809) |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2019-05-23 |