NPI | 1548608565 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207PS0010X Emergency Medicine, Sports Medicine (Licence: VA 0101278256) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD465726) |
207RS0010X Internal Medicine, Sports Medicine (Licence: PA MD465726) | |
Enumeration Date | 2013-06-12 |
Last Update Date | 2023-06-22 |