| NPI | 1679835649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 081004) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: GA 081004) |
| Enumeration Date | 2012-06-14 |
| Last Update Date | 2023-10-04 |