| NPI | 1417994898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A84415) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: CA A84415) |
| 208000000X Pediatrics (Licence: CA A84415) | |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2020-11-20 |