| NPI | 1639266679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: OH 35.137477) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: NY 60 238722) |
| 207R00000X Internal Medicine (Licence: NY 60 238722) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 60 238722) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2020-01-08 |