| NPI | 1255446399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: IN 002003452) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: FL OS7171) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2010-01-27 |