| NPI | 1558346510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: MA 237696) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 237696) |
| 208000000X Pediatrics (Licence: MA 237696) | |
| 2080S0010X Pediatrics, Sports Medicine (Licence: MA 237696) | |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2024-07-22 |