| NPI | 1346408820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: HI MD15206) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: PA MD432642) |
| 207RS0010X Internal Medicine, Sports Medicine (Licence: NY 252471) | |
| 207RS0010X Internal Medicine, Sports Medicine (Licence: NJ 25MA08368700) | |
| Enumeration Date | 2008-05-30 |
| Last Update Date | 2025-07-15 |