| NPI | 1376108324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 64135) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL 44363) |
| 207RS0010X Internal Medicine, Sports Medicine (Licence: TN 64135) | |
| Enumeration Date | 2019-05-06 |
| Last Update Date | 2024-09-03 |