| NPI | 1487632170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: NJ 25MB06246100) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: DE C2-0005338) |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2021-10-11 |