| NPI | 1588045090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: RI MD17977) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 273080) |
| 207RS0010X Internal Medicine, Sports Medicine (Licence: MA 273080) | |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2021-08-31 |