| NPI | 1366862328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2022-02179) |
| Additional Taxonomies | 207RS0010X Internal Medicine Sports Medicine (Licence: NC 2022-02179) |
| Enumeration Date | 2014-04-17 |
| Last Update Date | 2023-12-20 |