| NPI | 1467539940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301062711) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: MI 4301062711) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2013-10-04 |