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 |