| NPI | 1275995359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: CA 161481) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D89563) |
| 207RS0010X Internal Medicine, Sports Medicine (Licence: MD D89563) | |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2022-08-30 |