| 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 |