| NPI | 1497903678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: VA 0101254352) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: PA MT202855) |
| Enumeration Date | 2008-08-31 |
| Last Update Date | 2020-06-08 |