| NPI | 1679551352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A447380) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: CA A44738) |
| 207RS0010X Internal Medicine, Sports Medicine (Licence: CA A447380) | |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2010-02-19 |