| NPI | 1235544511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: TN 3886) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2018-00711) |
| Enumeration Date | 2014-06-25 |
| Last Update Date | 2025-05-28 |