| NPI | 1255587945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RS0010X Internal Medicine Sports Medicine (Licence: MI 4301093131) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301093131) |
| 208000000X Pediatrics (Licence: MI 4301093131) | |
| Enumeration Date | 2008-08-13 |
| Last Update Date | 2011-10-07 |