| NPI | 1568811289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: IL 036.159634) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036.159634) |
| Enumeration Date | 2016-06-03 |
| Last Update Date | 2023-09-20 |