| NPI | 1154422418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A65416) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: CA A65416) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2019-08-27 |