| NPI | 1518320811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine Sports Medicine (Licence: NJ 25MB10868000) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OS020240) |
| 207R00000X Internal Medicine (Licence: DE C2-0024451) | |
| 207RS0010X Internal Medicine Sports Medicine (Licence: DE C2-0024451) | |
| 207RS0010X Internal Medicine Sports Medicine (Licence: PA OS020240) | |
| Enumeration Date | 2016-04-04 |
| Last Update Date | 2024-03-05 |