| NPI | 1619362852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: IL 036155928) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 0000058974) |
| 207RS0010X Internal Medicine, Sports Medicine (Licence: TN 0000058974) | |
| Enumeration Date | 2015-04-04 |
| Last Update Date | 2021-12-13 |