| NPI | 1558704999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: GA 077712) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 077712) |
| 208000000X Pediatrics (Licence: GA 077712) | |
| Enumeration Date | 2013-04-16 |
| Last Update Date | 2018-07-09 |