| NPI | 1235166042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301082447) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: MI 4301082447) |
| 208000000X Pediatrics (Licence: MI 4301082447) | |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2017-12-07 |