| NPI | 1154688646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 271461) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: MA 271461) |
| 208000000X Pediatrics (Licence: MA 271461) | |
| Enumeration Date | 2012-04-20 |
| Last Update Date | 2022-07-21 |