| NPI | 1285097584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0102205018) |
| Additional Taxonomies | 207RS0010X Internal Medicine Sports Medicine (Licence: VA 0102205018) |
| Enumeration Date | 2016-04-04 |
| Last Update Date | 2024-09-04 |