| NPI | 1598775421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A96680) |
| Additional Taxonomies | 207RS0010X Internal Medicine Sports Medicine (Licence: CA A96680) |
| 208000000X Pediatrics (Licence: CA A96680) | |
| 171100000X Acupuncturist (Licence: CA A96680) | |
| 2080S0010X Pediatrics Sports Medicine (Licence: CA A96680) | |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2023-03-07 |