| NPI | 1174939706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine Sports Medicine (Licence: MN 62869) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 62869) |
| Enumeration Date | 2014-07-03 |
| Last Update Date | 2023-06-14 |