| NPI | 1316958051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 49540) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD00035391) |
| 207RS0010X Internal Medicine, Sports Medicine (Licence: WA MD00035391) | |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2021-05-17 |