| NPI | 1306810585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: OR 27489) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101238459) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2010-08-11 |