| NPI | 1497263388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: NY 311969) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 312068) |
| 207R00000X Internal Medicine (Licence: NJ 25MA10345700) | |
| Enumeration Date | 2018-01-14 |
| Last Update Date | 2022-02-10 |