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 |