| NPI | 1164455861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: HI MD6293) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: HI MD6293) |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2018-02-02 |