| NPI | 1508185794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: SD 10560) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: OR 166288) |
| Enumeration Date | 2010-05-27 |
| Last Update Date | 2017-11-13 |