| NPI | 1710470638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine Sports Medicine (Licence: IL 036-160596) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036-160596) |
| Enumeration Date | 2018-06-14 |
| Last Update Date | 2022-08-29 |