| NPI | 1255527008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine Sports Medicine (Licence: NY 264983) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 264983) |
| Enumeration Date | 2007-09-14 |
| Last Update Date | 2020-10-02 |