| NPI | 1720030752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: MN 64638) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: IL 036-095550) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2018-10-24 |