| NPI | 1629077326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 37457) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: KY 23513) |
| Enumeration Date | 2005-07-15 |
| Last Update Date | 2018-11-09 |