| NPI | 1275157828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: CA 20008) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 20008) |
| Enumeration Date | 2020-05-29 |
| Last Update Date | 2024-08-14 |