| NPI | 1689763633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 26375) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: GA 26375) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2024-03-07 |