| NPI | 1407830391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01045910A) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: IN 01045910A) |
| Enumeration Date | 2005-12-03 |
| Last Update Date | 2022-11-11 |