| NPI | 1669456174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: CA 20A 9975) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 20A9775) |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2023-07-21 |