| NPI | 1265011746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 1020086) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: MA 1020086) |
| Enumeration Date | 2021-04-03 |
| Last Update Date | 2026-06-02 |