| NPI | 1275973471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: MA 273027) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 255875) |
| Enumeration Date | 2013-07-02 |
| Last Update Date | 2018-03-29 |