| NPI | 1578651287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL 26959) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: AL MD.26959) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2020-09-21 |