| NPI | 1629118484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME64742) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: FL ME64742) |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: FL ME64742) | |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2020-03-03 |