| NPI | 1578192019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MS T-4146) |
| Additional Taxonomies | 207PS0010X Emergency Medicine, Sports Medicine (Licence: MS 29754) |
| Enumeration Date | 2020-04-06 |
| Last Update Date | 2025-02-25 |