| NPI | 1437116464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: FL ME113535) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME113535) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2020-12-22 |